The Chicago Breathe Project: A Multi‐Institution Educational Innovation to Improve Resident Knowledge and Skills in Caring for Patients with Inhalers

Background:

Asthma is responsible for a substantial proportion of ER visits and hospitalizations nationally, especially in minority communities. Since 2009, asthma patients have now been at increased risk because of a mandated replacement of the familiar generic metered dose inhalers (MDIs] with chlorofluorocartons (CFCs) with the environmentally friendly but harder to use and costlier hydrofluroalkane (HFAJ inhalers.

Purpose:

To create and disseminate an interactive case‐based education module and point‐of‐care tools via a resident collaborative, the Chicago Breathe Project, to improve resident physician knowledge and skills regarding HFA inhalers during this transition.

Description:

An initial needs assessment with a convenience sample of residents (n = 119, 84% response representing 15 residency programs) at The 2008 Illinois ACP Associates meeTing demonstrated that although 26% of residents stated that They knew The difference between an HFAand an MDI‐CFC inhaler, only 5% were able to correctly describe a difference and only 3% were aware of the upcoming policy change lo HFA inhalers. Only 49% could correctly identify the steps in using an inhaler. Patient focus groups demonstrated widespread confusion regarding HFA inhalers and how to use them. These results were used to inform the development of a case‐based interactive workshop. To arm residents with point‐of‐care tools tc improve their ability to teach about asthma, we created a pocket laminated card with inhalers side by side to compare costs, coverage, and use. made step‐by‐step inhaler checklists, and adopted an action plan. We also made instructional videos in partnership with Ihe Doctor's Channel. All tools were uploaded to a Web site easily located using the search term Chicago Breathe Project (http://www.linyurl.com/ChicagoBreatheProject). Trained residents taught skills monthly in 2 communities, one serving African Americans on the South Side of Chicago and one in partnership with Corazon Community Services in Cicero, serving Latino patients (bilingual moderators). Patient brochures were developed for 6th‐ to 8th‐grade readability. Resident workshops were held over the past year with 161 residents at 5 academic institutions. Following the workshop, 84% of residents reported feeling confident (confident or very confident) about their ability to use inhalers, and 75% could ascertain correct MDI steps. Residents also performed well on questions related to the new HFA inhalers: 91% knew at least 1 difference between the MDI‐CFC and the newer HFA type inhalers, and 62% knew of The policy change.

Conclusions:

Residents do not have sufficient knowledge about correct inhaler use or the switch to HFAs. Point‐of‐care educational tools and dissemination of a case‐based workshop can empower resident physicians wilh necessary knowledge and skills. These tools are easily accessible and are readily adopted by hospitalists who are caring for asthma and COPD patients during acute illness.

Author Disclosure:

V. Press, none; A. Pappalardo, none; W. Conwell, none; A. Pincavage, none; D. Baker, none; M. Prochaska, none: V, Arora, none.